• Home
  • Daily Tasks
    • Dictations >
      • Circumcision
      • Cystoscopy >
        • Cysto-OR
        • Cysto, +/- RPG +/- stent >
          • Cysto w/ b/l RPG
          • Cysto, L RPG
          • Cysto, R RPG
          • Cysto, L stent w/o RPG
          • Cysto, L RPG, L Stent
          • Cysto, R Stent w/o RPG
          • Cysto, R RPG, R Stent
        • Cysto, bladder biopsy
        • Cysto and TRUS Prostate Biopsy (OR)
        • Cysto Botox (F)
        • Individual parts of cystos
      • Prostate Biopsy >
        • Cysto and TRUS Prostate Biopsy (OR)
        • TRUS Prostate Biopsy (OR)
        • TRUS Prostate Biopsy (office)
        • MRI Fusion TRUS Prostate Biopsy
      • Robot Left Radical Nephrectomy
      • Robot Right Radical Nephrectomy
      • Robot Radical Prostatectomy w/ PLND
      • TURBT (M)
      • Ureteroscopy >
        • L U-scope (flex), RPG, (F)
        • R U-scope (flex), RPG, (M)
        • L U-scope,semirigid laser, flex, RPG, stent removal, (F)
      • ESWL >
        • Left Proximal ESWL
        • Left Renal ESWL
        • Right Proximal ESWL
        • Right Renal ESWL
      • TURP
      • Vasectomy
    • Plans >
      • Erectile Dysfunction
      • NMIBC
      • Peyronie's Disease
      • Prostate Cancer
    • Medications >
      • Antibiotics >
        • Bactrim
        • Cephalosporins >
          • Keflex
        • Ciprofloxacin
        • Macrobid
        • Gentamicin
      • Medications and Dialysis
      • Anticoagulation and Antiplatelets
      • 5α-Reductase Inhibitors
      • PDE5i
      • Prostate Cancer Drugs >
        • Abiraterone
        • Androgen Receptor Blockers
        • Pembrolizumab
      • Anticholinergics & β-3 Agonists
      • Estrace
    • Patient Discussions >
      • Prostate Cancer
      • PSA Screening
      • Tobacco Cessation
    • Radiation Exposure
    • Medicolegal
    • Urology Jokes & Quotes
  • Subjects
    • Various Pathology >
      • Neurogenic Bladder/Spinal Cord Injury
      • CKD/ESRD
      • Erectile Dysfunction >
        • IPP
      • Female Urology
      • Hypogonadism
      • Imaging
      • Nocturia
      • Overactive Bladder
      • Trauma
      • Urine Retention
    • Urologic Malignancy >
      • Prostate Cancer >
        • Choosing Therapy
        • Imaging
        • Genomic Testing
        • Locally Advanced and BCR
        • Metastatic Prostate Cancer
        • ADT and Hormonal Therapy
        • Surgery
        • Radiation
        • Adjuvant & Salvage Therapy
        • Prostate Biopsy
        • Studies >
          • Landmark Studies
          • Research
      • Bladder Cancer >
        • MIBC
        • NMIBC >
          • Intravesical Therapy
        • Urine Markers
        • Chemotherapy
        • Metastatic Bladder Cancer
        • Immunotherapy
        • Cystectomy & PLND
        • Variant Histology
        • Trimodal Therapy
        • Post Cystectomy Care (ERAS)
        • Studies
      • Renal Cancer >
        • Work-up
        • Treatment
        • Surgery
        • Renal Cysts
        • Locally Advanced & Metastatic
        • RCC Surveillance
        • Calculators & Nomograms
        • Landmark Studies
        • Other Studies
      • Upper Tract UCC >
        • Laser Treatment >
          • Studies
        • UTUC Chemotherapy
        • Surgery
        • Landmark Studies
      • Testicular Cancer >
        • Evaluation
        • Treatment
        • Surveillance
        • Landmark Studies
      • Penile Cancer
      • Urethral Cancer
      • Adrenal Lesions
    • Stones >
      • Studies
      • Evaluation
      • Treatment (Non Surgical)
      • Surgical Treatment
    • BPH >
      • TURP
      • Urolift
      • Surgical Therapies
      • IPSS
    • Fertility >
      • Imaging and Lab Tests
      • Work-up
      • Surgery
      • Infertility in Spinal Cord Injury
      • Study guide
      • Interventions
      • Studies
    • Infection >
      • Fournier's Gangrene
      • Orchitis
      • UTI
      • Recurrent UTI
    • Incontinence >
      • Artificial Urethral Sphincter
      • Neuromodulation
      • Slings
      • Urethral Bulking
    • Pediatric Urology >
      • Pediatric Infections
      • Pediatric Surgery
      • Pediatric Tumors
      • Pediatric Trauma
    • Reconstruction >
      • Ureteral Stricture
      • Urethral Stricture
      • Studies
    • Other Random Studies >
      • Blood Transfusions
      • Fistula
      • Other studies/notes
  • Procedures
    • Cystectomy
    • Incisions
    • Endoscopic >
      • Cystoscopy
      • Ureteroscopy
      • Ureteral Stenting
    • Female Surgery >
      • Interstim & PTNS
      • Midurethral Sling
      • Sacrocolpopexy
    • Nephrectomy
    • PCNL
    • Prostate Biopsy
    • Radical Prostatectomy
    • Suprapubic Tube (SPT)
    • Urethral Catheters
    • Urodynamics
    • Varicocelectomy
  • Videos
  • Journal Club
    • Top 1000 Urology Journal Articles
    • Top Urology Journal Articles by Decade
    • Landmark Authors
    • Bladder Cancer Journal Club >
      • Landmark Papers
    • Reconstructive Journal Club >
      • Landmark Papers
    • Upper Tract Urothelial Carcinoma
URORESIDENT.COM
  • Home
  • Daily Tasks
    • Dictations >
      • Circumcision
      • Cystoscopy >
        • Cysto-OR
        • Cysto, +/- RPG +/- stent >
          • Cysto w/ b/l RPG
          • Cysto, L RPG
          • Cysto, R RPG
          • Cysto, L stent w/o RPG
          • Cysto, L RPG, L Stent
          • Cysto, R Stent w/o RPG
          • Cysto, R RPG, R Stent
        • Cysto, bladder biopsy
        • Cysto and TRUS Prostate Biopsy (OR)
        • Cysto Botox (F)
        • Individual parts of cystos
      • Prostate Biopsy >
        • Cysto and TRUS Prostate Biopsy (OR)
        • TRUS Prostate Biopsy (OR)
        • TRUS Prostate Biopsy (office)
        • MRI Fusion TRUS Prostate Biopsy
      • Robot Left Radical Nephrectomy
      • Robot Right Radical Nephrectomy
      • Robot Radical Prostatectomy w/ PLND
      • TURBT (M)
      • Ureteroscopy >
        • L U-scope (flex), RPG, (F)
        • R U-scope (flex), RPG, (M)
        • L U-scope,semirigid laser, flex, RPG, stent removal, (F)
      • ESWL >
        • Left Proximal ESWL
        • Left Renal ESWL
        • Right Proximal ESWL
        • Right Renal ESWL
      • TURP
      • Vasectomy
    • Plans >
      • Erectile Dysfunction
      • NMIBC
      • Peyronie's Disease
      • Prostate Cancer
    • Medications >
      • Antibiotics >
        • Bactrim
        • Cephalosporins >
          • Keflex
        • Ciprofloxacin
        • Macrobid
        • Gentamicin
      • Medications and Dialysis
      • Anticoagulation and Antiplatelets
      • 5α-Reductase Inhibitors
      • PDE5i
      • Prostate Cancer Drugs >
        • Abiraterone
        • Androgen Receptor Blockers
        • Pembrolizumab
      • Anticholinergics & β-3 Agonists
      • Estrace
    • Patient Discussions >
      • Prostate Cancer
      • PSA Screening
      • Tobacco Cessation
    • Radiation Exposure
    • Medicolegal
    • Urology Jokes & Quotes
  • Subjects
    • Various Pathology >
      • Neurogenic Bladder/Spinal Cord Injury
      • CKD/ESRD
      • Erectile Dysfunction >
        • IPP
      • Female Urology
      • Hypogonadism
      • Imaging
      • Nocturia
      • Overactive Bladder
      • Trauma
      • Urine Retention
    • Urologic Malignancy >
      • Prostate Cancer >
        • Choosing Therapy
        • Imaging
        • Genomic Testing
        • Locally Advanced and BCR
        • Metastatic Prostate Cancer
        • ADT and Hormonal Therapy
        • Surgery
        • Radiation
        • Adjuvant & Salvage Therapy
        • Prostate Biopsy
        • Studies >
          • Landmark Studies
          • Research
      • Bladder Cancer >
        • MIBC
        • NMIBC >
          • Intravesical Therapy
        • Urine Markers
        • Chemotherapy
        • Metastatic Bladder Cancer
        • Immunotherapy
        • Cystectomy & PLND
        • Variant Histology
        • Trimodal Therapy
        • Post Cystectomy Care (ERAS)
        • Studies
      • Renal Cancer >
        • Work-up
        • Treatment
        • Surgery
        • Renal Cysts
        • Locally Advanced & Metastatic
        • RCC Surveillance
        • Calculators & Nomograms
        • Landmark Studies
        • Other Studies
      • Upper Tract UCC >
        • Laser Treatment >
          • Studies
        • UTUC Chemotherapy
        • Surgery
        • Landmark Studies
      • Testicular Cancer >
        • Evaluation
        • Treatment
        • Surveillance
        • Landmark Studies
      • Penile Cancer
      • Urethral Cancer
      • Adrenal Lesions
    • Stones >
      • Studies
      • Evaluation
      • Treatment (Non Surgical)
      • Surgical Treatment
    • BPH >
      • TURP
      • Urolift
      • Surgical Therapies
      • IPSS
    • Fertility >
      • Imaging and Lab Tests
      • Work-up
      • Surgery
      • Infertility in Spinal Cord Injury
      • Study guide
      • Interventions
      • Studies
    • Infection >
      • Fournier's Gangrene
      • Orchitis
      • UTI
      • Recurrent UTI
    • Incontinence >
      • Artificial Urethral Sphincter
      • Neuromodulation
      • Slings
      • Urethral Bulking
    • Pediatric Urology >
      • Pediatric Infections
      • Pediatric Surgery
      • Pediatric Tumors
      • Pediatric Trauma
    • Reconstruction >
      • Ureteral Stricture
      • Urethral Stricture
      • Studies
    • Other Random Studies >
      • Blood Transfusions
      • Fistula
      • Other studies/notes
  • Procedures
    • Cystectomy
    • Incisions
    • Endoscopic >
      • Cystoscopy
      • Ureteroscopy
      • Ureteral Stenting
    • Female Surgery >
      • Interstim & PTNS
      • Midurethral Sling
      • Sacrocolpopexy
    • Nephrectomy
    • PCNL
    • Prostate Biopsy
    • Radical Prostatectomy
    • Suprapubic Tube (SPT)
    • Urethral Catheters
    • Urodynamics
    • Varicocelectomy
  • Videos
  • Journal Club
    • Top 1000 Urology Journal Articles
    • Top Urology Journal Articles by Decade
    • Landmark Authors
    • Bladder Cancer Journal Club >
      • Landmark Papers
    • Reconstructive Journal Club >
      • Landmark Papers
    • Upper Tract Urothelial Carcinoma

Trimodal Therapy

Trimodal therapy (TMT) is maximum TUBRT, systemic chemotherapy and pelvic radiation.

A 2017 study looked at 40 patients over 80 w/ MIBC treated with TMT showed 54.9% OS at 3 yrs, which is comparable with radical cystectomy. RFS 42.3% at 3 years.  77% of these 40 were treated this due to underlying comorbities and 10% was for patient preference. (1) Other studies have shown complete response rates of 70-80% with 5 year DSS of 60-70% with TMT.  (
3,4)    A retrospective study of 342 patients who had a complete response to TMT had a recurrence rate of NMIBC of 25% at a median of 1.8yrs at a median follow up of 9 years.  After recurrence occurred and BCG induction there was a 59% recurrence free and 63% progression free survival. (2)

A large retrospective study of SEER data showed 
patients who underwent trimodal therapy had significantly decreased overall survival (hazard ratio [HR], 1.49; 95% CI, 1.31-1.69) and cancer-specific survival (HR, 1.55; 95% CI, 1.32-1.83). Median total costs were significantly higher with trimodal therapy than with radical cystectomy at 90 days ($80 174 vs $69 181) and at 180 days ($179 891 vs $107 017). (5)

​
  1. McPherson, Victor A., et al. "Chemoradiotherapy in octogenarians as primary treatment for muscle-invasive bladder cancer." Canadian Urological Association Journal11.1-2 (2017): 24.
  2. Sanchez, Alejandro, et al. "Incidence, Clinicopathological Risk Factors, Management and Outcomes of Nonmuscle Invasive Recurrence after Complete Response to Trimodality Therapy for Muscle Invasive Bladder Cancer." The Journal of urology199.2 (2018): 407-415.
  3. Giacalone, Nicholas J., et al. "Long-term outcomes after bladder-preserving tri-modality therapy for patients with muscle-invasive bladder cancer: an updated analysis of the Massachusetts General Hospital experience." European urology 71.6 (2017): 952-960.
  4. Efstathiou, Jason A., et al. "Long-term outcomes of selective bladder preservation by combined-modality therapy for invasive bladder cancer: the MGH experience." European urology 61.4 (2012): 705-711.
  5. Williams, Stephen B., et al. "Comparing Survival Outcomes and Costs Associated With Radical Cystectomy and Trimodal Therapy for Older Adults With Muscle-Invasive Bladder Cancer." JAMA surgery (2018).
Proudly powered by Weebly
  • Home
  • Daily Tasks
    • Dictations >
      • Circumcision
      • Cystoscopy >
        • Cysto-OR
        • Cysto, +/- RPG +/- stent >
          • Cysto w/ b/l RPG
          • Cysto, L RPG
          • Cysto, R RPG
          • Cysto, L stent w/o RPG
          • Cysto, L RPG, L Stent
          • Cysto, R Stent w/o RPG
          • Cysto, R RPG, R Stent
        • Cysto, bladder biopsy
        • Cysto and TRUS Prostate Biopsy (OR)
        • Cysto Botox (F)
        • Individual parts of cystos
      • Prostate Biopsy >
        • Cysto and TRUS Prostate Biopsy (OR)
        • TRUS Prostate Biopsy (OR)
        • TRUS Prostate Biopsy (office)
        • MRI Fusion TRUS Prostate Biopsy
      • Robot Left Radical Nephrectomy
      • Robot Right Radical Nephrectomy
      • Robot Radical Prostatectomy w/ PLND
      • TURBT (M)
      • Ureteroscopy >
        • L U-scope (flex), RPG, (F)
        • R U-scope (flex), RPG, (M)
        • L U-scope,semirigid laser, flex, RPG, stent removal, (F)
      • ESWL >
        • Left Proximal ESWL
        • Left Renal ESWL
        • Right Proximal ESWL
        • Right Renal ESWL
      • TURP
      • Vasectomy
    • Plans >
      • Erectile Dysfunction
      • NMIBC
      • Peyronie's Disease
      • Prostate Cancer
    • Medications >
      • Antibiotics >
        • Bactrim
        • Cephalosporins >
          • Keflex
        • Ciprofloxacin
        • Macrobid
        • Gentamicin
      • Medications and Dialysis
      • Anticoagulation and Antiplatelets
      • 5α-Reductase Inhibitors
      • PDE5i
      • Prostate Cancer Drugs >
        • Abiraterone
        • Androgen Receptor Blockers
        • Pembrolizumab
      • Anticholinergics & β-3 Agonists
      • Estrace
    • Patient Discussions >
      • Prostate Cancer
      • PSA Screening
      • Tobacco Cessation
    • Radiation Exposure
    • Medicolegal
    • Urology Jokes & Quotes
  • Subjects
    • Various Pathology >
      • Neurogenic Bladder/Spinal Cord Injury
      • CKD/ESRD
      • Erectile Dysfunction >
        • IPP
      • Female Urology
      • Hypogonadism
      • Imaging
      • Nocturia
      • Overactive Bladder
      • Trauma
      • Urine Retention
    • Urologic Malignancy >
      • Prostate Cancer >
        • Choosing Therapy
        • Imaging
        • Genomic Testing
        • Locally Advanced and BCR
        • Metastatic Prostate Cancer
        • ADT and Hormonal Therapy
        • Surgery
        • Radiation
        • Adjuvant & Salvage Therapy
        • Prostate Biopsy
        • Studies >
          • Landmark Studies
          • Research
      • Bladder Cancer >
        • MIBC
        • NMIBC >
          • Intravesical Therapy
        • Urine Markers
        • Chemotherapy
        • Metastatic Bladder Cancer
        • Immunotherapy
        • Cystectomy & PLND
        • Variant Histology
        • Trimodal Therapy
        • Post Cystectomy Care (ERAS)
        • Studies
      • Renal Cancer >
        • Work-up
        • Treatment
        • Surgery
        • Renal Cysts
        • Locally Advanced & Metastatic
        • RCC Surveillance
        • Calculators & Nomograms
        • Landmark Studies
        • Other Studies
      • Upper Tract UCC >
        • Laser Treatment >
          • Studies
        • UTUC Chemotherapy
        • Surgery
        • Landmark Studies
      • Testicular Cancer >
        • Evaluation
        • Treatment
        • Surveillance
        • Landmark Studies
      • Penile Cancer
      • Urethral Cancer
      • Adrenal Lesions
    • Stones >
      • Studies
      • Evaluation
      • Treatment (Non Surgical)
      • Surgical Treatment
    • BPH >
      • TURP
      • Urolift
      • Surgical Therapies
      • IPSS
    • Fertility >
      • Imaging and Lab Tests
      • Work-up
      • Surgery
      • Infertility in Spinal Cord Injury
      • Study guide
      • Interventions
      • Studies
    • Infection >
      • Fournier's Gangrene
      • Orchitis
      • UTI
      • Recurrent UTI
    • Incontinence >
      • Artificial Urethral Sphincter
      • Neuromodulation
      • Slings
      • Urethral Bulking
    • Pediatric Urology >
      • Pediatric Infections
      • Pediatric Surgery
      • Pediatric Tumors
      • Pediatric Trauma
    • Reconstruction >
      • Ureteral Stricture
      • Urethral Stricture
      • Studies
    • Other Random Studies >
      • Blood Transfusions
      • Fistula
      • Other studies/notes
  • Procedures
    • Cystectomy
    • Incisions
    • Endoscopic >
      • Cystoscopy
      • Ureteroscopy
      • Ureteral Stenting
    • Female Surgery >
      • Interstim & PTNS
      • Midurethral Sling
      • Sacrocolpopexy
    • Nephrectomy
    • PCNL
    • Prostate Biopsy
    • Radical Prostatectomy
    • Suprapubic Tube (SPT)
    • Urethral Catheters
    • Urodynamics
    • Varicocelectomy
  • Videos
  • Journal Club
    • Top 1000 Urology Journal Articles
    • Top Urology Journal Articles by Decade
    • Landmark Authors
    • Bladder Cancer Journal Club >
      • Landmark Papers
    • Reconstructive Journal Club >
      • Landmark Papers
    • Upper Tract Urothelial Carcinoma